Precision nutrition: Maintaining scientific integrity while realizing market potential

In Search of Healthy Ageing: A Microbiome-Based Precision Nutrition Approach for Type 2 Diabetes Prevention

Background/Objectives: Type 2 diabetes (T2D) is a leading cause of morbidity and mortality worldwide and in Spain, particularly in the elderly population, affecting healthy ageing. Nutritional strategies are key to its prevention. The gut microbiota is also implicated in T2D and can be modulated by nutrition. We hypothesize that precision nutrition through microbiota modulation may help prevent T2D. This article aims to (1) describe a gut microbiota bacterial profile associated with T2D prevention, (2) provide precision nutrition tools to optimize this profile, (3) analyze how overweight influences the microbiota composition and precision nutrition response, and (4) address the technical challenges of microbiome-based precision nutrition clinical implementation to prevent T2D. Methods: A review of gut microbiota associated with T2D prevention was conducted. 13 healthy Spanish participants over 62 with optimal blood glucose levels (7 normal weight and 6 overweight) underwent a 3-month precision nutrition intervention to optimize T2D-preventive gut microbiota using a bioinformatics food recommendation system, Phymofood (EP22382095). Fecal microbiota was analyzed pre- and post-intervention using full-length 16S rRNA gene amplification, MinION sequencing, and NCBI taxonomic classification. Results: 31 potentially preventive bacteria against T2D were selected. The intervention increased the relative abundance of beneficial genera (Butyrivibrio and Faecalibacterium) and species (Eshraghiella crossota, and Faecalibacterium prausnitzii). The overweight influenced microbiota composition and intervention response. Conclusions: A gut microbiota profile associated with T2D prevention was identified, and precision nutrition could increase the relative abundance of beneficial bacteria. Confounding factors such as overweight should be considered when designing microbiome-based precision nutrition interventions. These results contribute to a better understanding of the microbiota associated with T2D prevention and address technical challenges for clinical implementation in future healthy ageing strategies.

Integration of metabolomics and machine learning for precise management and prevention of cardiometabolic risk in Asians

Rapid changes in dietary patterns have led to a rise in cardiometabolic diseases (CMDs) worldwide, highlighting the urgent need for effective dietary strategies to address the health issues. Compared to Caucasians, Asians are more susceptible to CMDs. Understanding the complex factors driving this increased susceptibility is essential for developing targeted interventions and preventive measures for Asian populations. Metabolomics plays a key role in identifying specific metabolic markers and pathways associated with CMDs, providing insights into disease mechanisms and helping to create individualized risk profiles. However, metabolomics faces several challenges, including difficulties in interpreting results across diverse ethnic groups, limitations in study design, variability in analytical platforms, and inconsistencies in data processing methods. Overcoming these challenges requires the adoption of advanced technologies, standardized approaches, and integration of multi-omics data to maximize the utility of metabolomics in clinical settings. As the volume and complexity of metabolomic data continue to increase, machine learning (ML) algorithms have become essential for effective data integration, interpretation, and knowledge extraction. Advanced ML techniques, such as deep learning and network analysis, can reveal hidden patterns, relationships, and metabolic pathways within large datasets, leading to deeper insights into biological systems and disease processes. By combining metabolomics and ML, we can facilitate early detection, enable personalized interventions, and support the development of targeted nutritional strategies, ultimately improving therapeutic outcomes and reducing the socioeconomic burden of CMDs in this region.

Differential weight-loss responses of APOA2 genotype carriers to low-carbohydrate and low-fat diets: the DIETFITS trial

OBJECTIVE

This study aimed to determine whether APOA2 genotypes and saturated fatty acid (SAT) intake affect weight-loss response to healthy low-carbohydrate (HLC) and healthy low-fat (HLF) diets.

METHODS

This is a secondary analysis of the Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) study, a 12-month randomized clinical trial of HLC or HLF diets in 609 adults aged 18 to 50 years with BMI values between 28 and 40 kg/m2. The current study examined 3-, 6-, and 12-month weight loss in participants with different APOA2 genotypes (TT vs. C allele carriers, CT + CC) at variant rs5082 who met the SAT intake criterion of ≥22 g/day for an HLC diet and < 22 g/day for an HLF diet at all three study time points.

RESULTS

Participants with the TT APOA2 genotype lost significantly more weight consistently on an HLC diet than on an HLF diet at 3, 6, and 12 months, whereas C allele carriers lost more weight only at 3 months and not at 6 or 12 months. APOA2 genotype-by-SAT intake interaction affecting weight loss was observed only at 12 months. Among participants who did not consistently meet the SAT intake criterion, there were no significant weight-loss differences among APOA2 genotypes.

CONCLUSIONS

This study highlights the importance of evaluating genotype-diet interactions in weight-loss trials to better inform precision nutrition interventions.

CLINICAL TRIAL REGISTRATION

NCT01826591.

Precision nutrition: Is tailor‑made dietary intervention a reality yet? (Review)

Precision nutrition (PN) is an emerging field of science recognizing the variability in how individuals respond to different nutrients, driven by their unique biological makeup. The central aim of PN is to tailor dietary interventions to improve individual health, prevent disease and manage existing health conditions based on specific biological characteristics. The present review aimed to provide an overview of available multi-omics platforms that can be applied to extracting data from biological materials in the context of PN. Additionally, it proposed an updated pipeline for handling and integrating these data. A comprehensive search of academic publications was conducted across multiple databases, focusing on recent advances in PN, including its challenges and opportunities. Following this preparatory step, a data handling protocol for different omics layers was compiled to develop an up-to-date multi-omics pipeline applicable to PN. The successful implementation of PN requires a systems-level understanding of human physiological networks, their plasticity, variations in response to dietary exposures and the ability to classify population subgroups based on their nutritional needs. The realization of PN may currently seem distant due to several limitations such as the lack of ongoing large-scale epidemiological studies, challenges in database curation, the high cost of omics analysis and ethical concerns. A key advancement to this field would be the development of next-generation biomarkers connecting nutrition to chronic diseases. These biomarkers would help classify individuals at risk of diet-related conditions and quantify the dose-response relationships between individuals or groups of interacting nutrients and the onset and progression of diseases.

AI-based system for food and beverage selection towards precision nutrition in Indonesian restaurants

The complexity surrounding food selection is attributable to the variability in foods, restaurants, and diners. The diversity of foods, where each dish may have a unique recipe across different restaurants, needs to be accounted for in personalized nutrition. However, personalized food selection poses a combinatorial challenge in selecting the most suitable food at a specific restaurant. The key question is how a diner visiting a particular restaurant can be assisted in selecting optimal foods and beverages based on factors such as sex, age, height, weight, and history of non-communicable diseases (NCDs). In this study, a genetic algorithm (GA) is used to develop a system that can address this issue in the context of Indonesian restaurants. In this system, a database with data on registered diners and foods is maintained. Foods comprise staple foods, side dishes, vegetables, and beverages, each containing its energy and nutrient content for a given restaurant. The nutritional adequacy of a single meal is determined by comparing the energy and nutrient content of the menu with the diner's nutritional needs. The novelty of the proposed system lies in combining scientific nutritional data with individual diner profiles for the selection of the best meal for a diner. This system differs from the existing food recommender applications in Indonesia, which typically do not consider specific diners, personalized nutrition, and NCD history. The proposed system is the first developed application prototype for Indonesian restaurants to overcome the inefficiency of the existing applications. In this study, the structure and chromosome content of the food, its corresponding energy and nutrient contents, and GA operators such as crossover, mutation, and tournament selection for determining the best meal using the defined fitness functions are discussed. The proposed system has been tested at Karimata Restaurant and proved to be highly suitable for the ultimate goal of meal selection for individual diners with different needs, and it can be replicated at other restaurants. Furthermore, user-centered evaluation has revealed that the system (a) increases nutritional understanding and health awareness; (b) is easy to use with comprehensive functions; and (c) promotes user satisfaction with personalized recommendations.

Perspective: Challenges for Personalized Nutrition in the Current United States Regulatory Framework and Future Opportunities

Personalized nutrition (PN) aims to provide tailored dietary recommendations to improve a person's health outcomes by integrating a multitude of individual-level information and supporting desired behavior changes. The field is rapidly evolving with technological advances. As new biomarkers are discovered, wearables and other devices can now provide up-to-the-minute insights, and artificial intelligence and machine learning models support recommendations and lifestyle behavior change. Advancements in the field enhance the potential for tailored and effective programs but raise important questions regarding user safety, security, health, transparency, and privacy. The Personalized Nutrition Initiative at the University of Illinois held the workshop, "Challenges for Personalized Nutrition in the Current United States Regulatory Framework and Future Opportunities," to address regulatory implications of current PN programs, future innovation within the current framework, and existing complexities of oversight. A majority of PN programs combine multiple components, and these components may need to be regulated differently. The areas of food, supplements, in vitro diagnostics, and medical and wellness devices were described and discussed as they apply to PN programs. The speakers and discussants concluded that regulatory guidance for PN programs should focus on ensuring 1) safety and accuracy of the tests and devices, 2) credentialed and skilled experts develop the advice, 3) responsible and clear communication of information and benefits, 4) substantiation of scientific claims, and 5) procedures are implemented to protect user privacy. Furthermore, as this field incorporates new devices, biomarkers, behavior-based tools, and the integration of artificial intelligence and machine learning, the need to adapt the existing regulatory framework was also considered. Working closely with regulatory bodies is required and should be an opportunity to provide users with transparency, build trust, and create a source of differentiation for PN innovators.

Effect of a Multifactorial Weight Loss Intervention on HDL Cholesterol Efflux Capacity and Immunosenescence: A Randomized Controlled Trial

OBJECTIVE

Life expectancy and obesity prevalence are increasing worldwide, leading to an increase in the prevalence of cardiovascular disease. High-density lipoprotein (HDL) functionality and immunosenescence play key roles in cardiovascular disease, longevity, and quality of aging. Both molecular hallmarks of aging are impacted by obesity and metabolic syndrome and can be modulated by lifestyle. We aimed to evaluate the effect of a lifestyle intervention focused on an energy-reduced Mediterranean diet (erMedDiet), physical activity (PA), and behavioral support on HDL cholesterol efflux capacity (CEC) and immunosenescence.

METHOD

CEC and immunosenescent T cells were determined in 60 participants from the control group (CG) and 56 from the intervention group (IG) of the PREDIMED-Plus trial at baseline and after 1 and 3 years of follow-up. PREDIMED-Plus is a randomized, controlled, parallel-group trial with an IG of erMedDiet, PA promotion, and behavioral support for weight loss and a CG of usual primary care advice. The sample included 116 volunteers from the PREDIMED-Plus-IMDEA subsample of the PREDIMED-Plus trial. Men aged 55 to 75 years and women aged 60 to 75 years with a body mass index between 27 and 40 kg/m2 and metabolic syndrome were included.

RESULTS

Participants within the IG had significantly improved CEC (2.42% and 10.69% after 1 and 3 years of follow-up) and a decreased in senescent T cell profile (-3.32% ± 12.54% and -6.74% ± 11.2%, p < 0.001, after 1 and 3 years of follow-up). Baseline obesity status impacted the response to the intervention.

CONCLUSIONS

A weight loss intervention program with erMedDiet and PA ameliorated senescence markers.

Conjugated linoleic acid metabolite impact in colorectal cancer: a potential microbiome-based precision nutrition approach

Colorectal cancer (CRC) is the second most deadly and the third most diagnosed cancer in both sexes worldwide. CRC pathogenesis is associated with risk factors such as genetics, alcohol, smoking, sedentariness, obesity, unbalanced diets, and gut microbiota dysbiosis. The gut microbiota is the microbial community living in symbiosis in the intestine, in a dynamic balance vital for health. Increasing evidence underscores the influence of specific gut microbiota bacterial species on CRC incidence and pathogenesis. In this regard, conjugated linoleic acid (CLA) metabolites produced by certain gut microbiota have demonstrated an anticarcinogenic effect in CRC, influencing pathways for inflammation, proliferation, and apoptosis. CLA production occurs naturally in the rumen, and human bioavailability is through the consumption of food derived from ruminants. In recent years, biotechnological attempts to increase CLA bioavailability in humans have been unfruitful. Therefore, the conversion of essential dietary linoleic acid to CLA metabolite by specific intestinal bacteria has become a promising process. This article reviews the evidence regarding CLA and CLA-producing bacteria as therapeutic agents against CRC and investigates the best strategy for increasing the yield and bioavailability of CLA. Given the potential and limitations of the present strategies, a new microbiome-based precision nutrition approach based on endogenous CLA production by human gut bacteria is proposed. A literature search in the PubMed and PubMed Central databases identified 794 papers on human gut bacteria associated with CLA production. Of these, 51 studies exploring association consistency were selected. After excluding 19 papers, due to health concerns or discrepancies between studies, 32 papers were selected for analysis, encompassing data for 38 CLA-producing bacteria, such as Bifidobacterium and Lactobacillus species. The information was analyzed by a bioinformatics food recommendation system patented by our research group, Phymofood (EP22382095). This paper presents a new microbiome-based precision nutrition approach targeting CLA-producing gut bacterial species to maximize the anticarcinogenic effect of CLA in CRC.

Data in Personalized Nutrition: Bridging Biomedical, Psycho-behavioral, and Food Environment Approaches for Population-wide Impact

Personalized nutrition (PN) represents an approach aimed at delivering tailored dietary recommendations, products, or services to support both prevention and treatment of nutrition-related conditions and to improve individual health using genetic, phenotypic, medical, nutritional, and other pertinent information. However, current approaches have yielded limited scientific success in improving diets or in mitigating diet-related conditions. In addition, PN currently caters to a specific subgroup of the population rather than having a widespread impact on diet and health at a population level. Addressing these challenges requires integrating traditional biomedical and dietary assessment methods with psycho-behavioral, and novel digital and diagnostic methods for comprehensive data collection, which holds considerable promise in alleviating present PN shortcomings. This comprehensive approach not only allows for deriving personalized goals ("what should be achieved") but also customizing behavioral change processes ("how to bring about change"). We herein outline and discuss the concept of "Adaptive Personalized Nutrition Advice Systems," which blends data from 3 assessment domains: 1) biomedical/health phenotyping; 2) stable and dynamic behavioral signatures; and 3) food environment data. Personalized goals and behavior change processes are envisaged to no longer be based solely on static data but will adapt dynamically in-time and in-situ based on individual-specific data. To successfully integrate biomedical, behavioral, and environmental data for personalized dietary guidance, advanced digital tools (e.g., sensors) and artificial intelligence-based methods will be essential. In conclusion, the integration of both established and novel static and dynamic assessment paradigms holds great potential for transitioning PN from its current focus on elite nutrition to a widely accessible tool that delivers meaningful health benefits to the general population.

The Contribution of Precision Nutrition Intervention in Subfertile Couples

BACKGROUND/AIM

Subfertility is characterized by a decrease in reproductive efficiency, which can result in delayed pregnancy, and affects one in six individuals during their lifetime. The present narrative review aims to evaluate the contribution of precision nutrition to changes in fertility in subfertile couples.

METHODS

The literature review was carried out through bibliographic research in the PubMed, Scopus, SciELO and Google Scholar databases. The following search criteria were applied: (1) original articles and narrative, systematic or meta-analytic reviews, and (2) the individual or combined use of the following keywords: "genetic variation", "nutrigenetics", "precision nutrition", "couple's subfertility", and "couple's infertility". A preliminary reading of all the articles was carried out, and only those that best fit the themes and subthemes of the narrative review were selected.

RESULTS

Scientific evidence suggests that adherence to a healthy diet that follows the Mediterranean pattern is associated with increased fertility in women and improved semen quality in men, better metabolic health and reduced levels of inflammation and oxidative stress, as well as maintaining a healthy body weight. The integration of different tools, such as nutrigenetics, predictive biochemical analyses, intestinal microbiota tests and clinical nutrition software, used in precision nutrition interventions can contribute to providing information on how diet and genetics interact and how they can influence fertility.

CONCLUSIONS

The adoption of a multidisciplinary and precision approach allows the design of dietary and lifestyle recommendations adapted to the specific characteristics and needs of couples with subfertility, thus optimizing reproductive health outcomes and achieving successful conception.

Understanding the Genetic Architecture of Vitamin Status Biomarkers in the Genome-Wide Association Study Era: Biological Insights and Clinical Significance

Vitamins play an intrinsic role in human health and are targets for clinical intervention through dietary or pharmacological approaches. Biomarkers of vitamin status are complex traits, measurable phenotypes that arise from an interplay between dietary and other environmental factors with a genetic component that is polygenic, meaning many genes are plausibly involved. Studying these genetic influences will improve our knowledge of fundamental vitamin biochemistry, refine estimates of the effects of vitamins on human health, and may in future prove clinically actionable. Here, we evaluate genetic studies of circulating and excreted biomarkers of vitamin status in the era of hypothesis-free genome-wide association studies (GWAS) that have provided unprecedented insights into the genetic architecture of these traits. We found that the most comprehensive and well-powered GWAS currently available were for circulating status biomarkers of vitamin A, C, D, and a subset of the B vitamins (B9 and B12). The biology implicated by GWAS of measured biomarkers of each vitamin is then discussed, both in terms of key genes and higher-order processes. Across all major vitamins, there were genetic signals revealed by GWAS that could be directly linked with known vitamin biochemistry. We also outline how genetic variants associated with vitamin status biomarkers have been already extensively used to estimate causal effects of vitamins on human health outcomes, which is particularly important given the large number of randomized control trials of vitamin related interventions with null findings. Finally, we discuss the current evidence for the clinical applicability of findings from vitamin GWAS, along with future directions for the field to maximize the utility of these data.

Guidance and Position of RINN22 regarding Precision Nutrition and Nutriomics

BACKGROUND

Precision nutrition is based on the integration of individual's phenotypical and biological characteristics including genetic variants, epigenetic marks, gut microbiota profiles, and metabolite fingerprints as well as medical history, lifestyle practices, and environmental and cultural factors. Thus, nutriomics areas including nutrigenomics, nutrigenetics, nutriepigenetics, nutrimetabolomics, and nutrimetagenomics have emerged to comprehensively understand the complex interactions between nutrients, diet, and the human body's molecular processes through precision nutrition.

SUMMARY

This document from the Ibero-American Network of Nutriomics and Precision Nutrition (RINN22; https://rinn22.com/) provides a comprehensive overview of the concepts of precision nutrition approaches to guide their application in clinical and public health as well as establish the position of RINN22 regarding the current and future state of precision nutrition.

KEY MESSAGES

The progress and participation of nutriomics to precision nutrition is an essential pillar for addressing diet-related diseases and developing innovative managing strategies, which will be promoted by advances in bioinformatics, machine learning, and integrative software, as well as the description of specific novel biomarkers. In this context, synthesizing and critically evaluating the latest developments, potential applications, and future needs in the field of nutrition is necessary with a holistic perspective, incorporating progress in omics technologies aimed at precision nutrition interventions. This approach must address and confront healthy, social, food security, physically active lifestyle, sanitation, and sustainability challenges with preventive, participatory, and predictive strategies of personalized, population, and planetary nutrition for a precision tailored health.

Associations between eating habits and mental health among adolescents in five nordic countries: a cross-sectional survey

BACKGROUND

The role of eating habits in adolescent mental health has become a growing area of interest for researchers and health professionals. Recent studies suggest that healthy eating habits may play a role in the development and management of mental health. However, existing literature is largely based on clinical populations, and comparisons are challenged by sociocultural differences and methodological issues. The aim of the present study was to use nationally representative data based on standardized procedures, to explore associations between adolescents eating habits and mental health, considering the importance of age, gender, socioeconomic factors, and country.

METHODS

The study was based on data from Nordic adolescents (age 11, 13 and 15 years) who participated in the 2017/2018 Health Behavior in School-aged Children (HBSC) study (n = 22384). General linear modelling and multigroup regression analysis were used to examine the relationship between food habits (intake of fruit, vegetables, sweets, soft drinks), meal habits (intake of breakfast and having family meals together), and mental health (life satisfaction and subjective health complaints). The analyses were weighted and adjusted for age, gender, socio-economic status, and country.

RESULTS

Overall, healthier eating habits were associated with better mental health. The strongest associations were found between meal habits (breakfast consumption and having family meals together) and mental health. Gender and country differences were seen, with weaker associations found among Danish boys.

CONCLUSION

Eating habits should be considered when promoting mental health in the adolescent population. While gender differences and cross-country variations exist, even minor enhancements in eating behaviors could yield meaningful benefits.

Innovative solution or cause for concern? The use of continuous glucose monitors in people not living with diabetes: A narrative review

AIMS

Continuous glucose monitors (CGMs) have expanded their scope beyond indicated uses for diabetes management and are gaining traction among people not living with diabetes (PNLD). CGMs track in time glucose levels and are proposed as tools for the early detection of abnormal glucose and a potential solution for its normalisation through behavioural change, particularly, diet personalisation and motivation of physical activity. This becomes relevance given the growing incidence of metabolic conditions, such as type 2 diabetes mellitus (T2DM). Clinical guidelines, however, do not recommend CGMs in contexts outside type 1 diabetes (T1DM) or insulin-treated T2DM. Therefore, there is a visible disconnect between the indicated and real-world usage of these medical devices. While the commercial market for CGMs in PNLD is expanding rapidly, a comprehensive and evidence-based evaluation of the devices' utility in this population has not been done. Therefore, this review aims to formulate a working model for CGM utility in PNLD as proposed by the 'health and wellness' market that advertises and distributes it to these individuals.

METHODS

We aim to critically analyse the available research addressing components of the working model, that is (1) detection of abnormal glucose; (2) behavioural change, and (3) metabolic health improvement.

RESULTS

We find a lack of consistent and high-quality evidence to support the utility of CGMs for these purposes. We identify significantly under-reserved areas including clinical benchmarks and scoring procedures for CGM measures, device acceptability, and potential adverse effects of CGMs on eating habits in PNLD. We also raise concerns about the robustness of available CGM research.

CONCLUSION

In the face of these research gaps, we urge for the commercial claims suggesting the utility of the device in PNLD to be labelled as misleading. We argue that there is a regulatory inadequacy that fuels 'off-label' CGM distribution and calls for the strengthening of post-market clinical follow-up oversight for CGMs. We hope this will help to avert the continued misinformation risk to PNLD and 'off-label' exacerbation of health disparities.

Personalized nutrition: aligning science, regulation, and marketing

Interest in personalized nutrition among researchers and industry has grown rapidly in recent years and shows no signs of abating. In this paper, we discuss the growth of the personalized nutrition market, the evidence for the approach, and the regulatory landscape for personalized nutrition products. We found that regulatory gaps have led to market growth of products with unknown efficacy that are making bold, and possibly unsubstantiated, claims. As personalized nutrition products and related treatments continue to enter the market without regulation, unreliable products may cause consumers financial, psychological, and physical harm. Stronger regulation will help engender trust in these products among consumers and ensure their safety and effectiveness.

A Life-Stage Approach to Precision Nutrition: A Narrative Review

The concept of precision nutrition highlights the customization of nutrition to specific needs, emphasizing that a one-size-fits-all approach is not sufficient for either optimal nutrition or optimal health. Precision nutrition encompasses a range of factors, from broad strata of age and sex categories to personal characteristics such as lifestyle to an individual's unique genotype. This breadth of scope requires us to consider how precision nutrition can be implemented in an inclusive and appropriate way for individuals and groups within real-life populations. In this narrative review, we explore the potential of precision nutrition through a life-stage approach that emphasizes age- and gender-specific nutritional needs as these change across the lifespan. Focusing on adult life stages, we delineated trends in age-related conditions and health needs among Korean adults based on national-level survey data (KNHANES 2019-2021). We also reviewed the intake of nutrients associated with these health needs to better understand how life-stage guided approaches to nutrition and supplementation could support optimal health. Looking beyond preventing deficiency or disease, we discuss how tailored supplementation of essential vitamins, minerals, and certain bioactive substances could promote healthy functioning. Finally, we discuss the complexities and challenges of developing multivitamin/multimineral supplements (MVMS) to support life-stage appropriate nutrition while maximizing adherence. Future prospects include leveraging advancements in intelligent technologies and dietary assessments for tracking nutrient intake and health indicators and using these to optimize MVMS formulations in ways that are sensitive to a person's needs and priorities/preferences at different life stages. By adopting a life-stage guided approach to nutrition, we can better support health and well-being across the lifespan.

The Evolution of Science and Regulation of Dietary Supplements: Past, Present, and Future

Dietary supplement use in the United States is widespread and increasing, especially among certain population groups, such as older Americans. The science surrounding dietary supplements has evolved substantially over the last few decades since their formal regulation in 1994. Much has been learned about the mechanisms of action of many dietary supplement ingredients, but the evidence on their health effects is still building. As is true of much nutrition research, there are many studies that point to health effects, but not all are at the level of scientific evidence (e.g., randomized controlled interventions), rigor, or quality needed for definitive statements of efficacy regarding clinical end points. New technologies and approaches are being applied to the science of dietary supplements, including nutrigenomics and microbiome analysis, data science, artificial intelligence (AI), and machine learning-all of which can elevate the science behind dietary supplements. Products can contain an array of bioactive compounds derived from foods as well as from medicinal plants, which creates enormous challenges in data collection and management. Clinical applications, particularly those aimed at providing personalized nutrition options for patients, have become more sophisticated as dietary supplements are incorporated increasingly into clinical practice and self-care. The goals of this article are to provide historical context for the regulation and science of dietary supplements, identify research resources, and suggest some future directions for science in this field.

A health technology assessment of personalized nutrition interventions using the EUnetHTA HTA Core Model

OBJECTIVES

Poor nutrition links to chronic diseases, emphasizing the need for optimized diets. The EU-funded project PREVENTOMICS, introduced personalized nutrition to address this. This study aims to perform a health technology assessment (HTA) comparing personalized nutrition interventions developed through this project, with non-personalized nutrition interventions (control) for people with normal weight, overweight, or obesity. The goal is to support decisions about further development and implementation of personalized nutrition.

METHODS

The PREVENTOMICS interventions were evaluated using the European Network for HTA Core Model, which includes a methodological framework that encompasses different domains for value assessment. Information was gathered via [1] different statistical analyses and modeling studies, [2] questions asked of project partners and, [3] other (un)published materials.

RESULTS

Clinical trials of PREVENTOMICS interventions demonstrated different body mass index changes compared to control; differences ranged from -0.80 to 0.20 kg/m2. Long-term outcome predictions showed generally improved health outcomes for the interventions; some appeared cost-effective (e.g., interventions in UK). Ethical concerns around health inequality and the lack of specific legal regulations for personalized nutrition interventions were identified. Choice modeling studies indicated openness to personalized nutrition interventions; decisions were primarily affected by intervention's price.

CONCLUSIONS

PREVENTOMICS clinical trials have shown promising effectiveness with no major safety concerns, although uncertainties about effectiveness exist due to small samples (n=60-264) and short follow-ups (10-16 weeks). Larger, longer trials are needed for robust evidence before implementation could be considered. Among other considerations, developers should explore financing options and collaborate with policymakers to prevent exclusion of specific groups due to information shortages.

The Science of Precision Prevention: Research Opportunities and Clinical Applications to Reduce Cardiovascular Health Disparities

Precision prevention embraces personalized prevention but includes broader factors such as social determinants of health to improve cardiovascular health. The quality, quantity, precision, and diversity of data relatable to individuals and communities continue to expand. New analytical methods can be applied to these data to create tools to attribute risk, which may allow a better understanding of cardiovascular health disparities. Interventions using these analytic tools should be evaluated to establish feasibility and efficacy for addressing cardiovascular disease disparities in diverse individuals and communities. Training in these approaches is important to create the next generation of scientists and practitioners in precision prevention. This state-of-the-art review is based on a workshop convened to identify current gaps in knowledge and methods used in precision prevention intervention research, discuss opportunities to expand trials of implementation science to close the health equity gaps, and expand the education and training of a diverse precision prevention workforce.

Diet-Nutrition Information Seeking, Source Trustworthiness, and Eating Behavior Changes: An International Web-Based Survey

To understand the extent to which different sources of diet and nutrition information are sought, trusted, and relied upon for making dietary changes, the present international web-based survey study gauged participants' (n = 3419) diet-nutrition information-seeking behaviors from 22 interpersonal and general sources with varying quality, trust levels in these sources, and reliance on each source for making dietary changes. Qualitative insights were also captured regarding trustworthiness formation. The results revealed a disconnect between source popularity and perceived trustworthiness. While nutrition-health websites, Google-Internet searches, and diet-health books were most commonly consulted, participants placed the highest level of trust in nutrition scientists, nutrition professionals, and scientific journals, suggesting that frequent information seeking from a subpar source may not be a reliable predictor of the level of trust assigned to it. Although the frequency of source-seeking behaviors and source trustworthiness both contributed to dietary changes, the latter appeared to have a more pronounced influence. When a source was less trusted, there was a reduced likelihood of relying on it for changing diet. Additionally, source seeking may not always translate into effective dietary change, as shown by the less strong correlation between the two. These associations significantly differed depending on the source.

Precision Nutrition Opportunities to Help Mitigate Nutrition and Health Challenges in Low- and Middle-Income Countries: An Expert Opinion Survey

Precision nutrition involves several data collection methods and tools that aim to better inform nutritional recommendations and improve dietary intake, nutritional status, and health outcomes. While the benefits of collecting precise data and designing well-informed interventions are vast, it is presently unclear whether precision nutrition is a relevant approach for tackling nutrition challenges facing populations in low- and middle-income countries (LMIC), considering infrastructure, affordability, and accessibility of approaches. The Swiss Food & Nutrition Valley (SFNV) Precision Nutrition for LMIC project working group assessed the relevance of precision nutrition for LMIC by first conducting an expert opinion survey and then hosting a workshop with nutrition leaders who live or work in LMIC. The experts were interviewed to discuss four topics: nutritional problems, current solutions, precision nutrition, and collaboration. Furthermore, the SFNV Precision Nutrition for LMIC Virtual Workshop gathered a wider group of nutrition leaders to further discuss precision nutrition relevance and opportunities. Our study revealed that precision public health nutrition, which has a clear focus on the stratification of at-risk groups, may offer relevant support for nutrition and health issues in LMIC. However, funding, affordability, resources, awareness, training, suitable tools, and safety are essential prerequisites for implementation and to equitably address nutrition challenges in low-resource communities.

Diet and Food and Nutrition Insecurity and Cardiometabolic Disease

Poor nutrition is the leading cause of poor health, health care spending, and lost productivity in the United States and globally, which acts through cardiometabolic diseases as precursors to cardiovascular disease, cancer, and other conditions. There is great interest in how the social determinants of health (the conditions in which people are born, live, work, develop, and age) impact cardiometabolic disease. Food insecurity is an example of a powerful social determinant of health that impacts health outcomes. Nutrition insecurity, a distinct but related concept to food insecurity, is a direct determinant of health. In this article, we provide an overview of how diet in early life relates to cardiometabolic disease and then continue to focus on the concepts of food insecurity and nutrition insecurity. In the discussions herein we make important distinctions between the concepts of food insecurity and nutrition insecurity and provide a review of their concepts, histories, measurement and assessment devices, trends and prevalence, and links to health and health disparities. The discussions here set the stage for future research and practice to directly address the negative consequences of food and nutrition insecurity.

Consumption of Common Bean Suppresses the Obesogenic Increase in Adipose Depot Mass: Impact of Dose and Biological Sex

Obesity prevention is stated as a simple objective in the public health guidelines of most countries: avoid adult weight gain. However, the success of the global population in accomplishing this goal is limited as reflected in the persisting pandemic of overweight and obesity. While many intervention strategies have been proposed, most are directed at mitigating the consequences of obesity. Efforts intended to prevent unintentional weight gain and associated adiposity are termed anti-obesogenic. Herein, evidence is presented that a neglected category of foods, pulses, i.e., grain legumes, have anti-obesogenic activity. Using a preclinical mouse model of obesity, a dose-response study design in animals of both biological sexes, and cooked, freeze-dried, and milled common bean as a representative pulse, data are presented showing that the rate of body weight gain is slowed, and fat accumulation is suppressed when 70% of the dietary protein is provided from common bean. These anti-obesogenic effects are reduced at lower amounts of common bean (17.5% or 35%). The anti-obesogenic responsiveness is greater in female than in male mice. RNA sequence analysis indicates that the sex-related differences extend to gene expression patterns, particularly those related to immune regulation within adipose tissue. In addition, our findings indicate the potential value of a precision nutrition approach for human intervention studies that identify "pulse anti-obesogenic responders". A precision approach may reduce the concentration of pulses required in the diet for benefits, but candidate biomarkers of responsivity to pulse consumption remain to be determined.

Evidence-Based Lifestyle Guidelines and Self-Management Strategies Utilized by Women with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a complex endocrine disorder, affecting 13% of reproductive-aged women. While lifestyle management is the first-line treatment for improving complications, women experience challenges with implementation. This cross-sectional study aims to identify the types and sources of dietary and physical activity (PA) interventions implemented by women with PCOS and understand how they use self-management strategies to support lifestyle change. An online questionnaire was disseminated via a consumer-based PCOS website (May 2015-2016). Women (n = 1167) were aged 18-45 years and primarily born within the United States (70%). A quarter or less of women (diet 25%, PA 14%) sought lifestyle advice from health professionals (medical clinicians or dietitians) compared to over half (diet 59%, PA 67%) using alternative sources, namely from online platforms. While only 33% and 16% of women reported following formal dietary or PA guidelines, respectively, 57% had implemented a 'special diet' to manage their condition, many of which were inconsistent with evidence-based practice in PCOS. Participants also displayed a low level of engagement with important self-management behaviors, including goal setting and positive self-talk. These findings suggest that online information may promote inaccurate and ineffective lifestyle advice and emphasize the need to increase engagement with qualified health professionals.